MNT for Individuals III

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MNT for Individuals III
2013-02-08 19:11:10
dietetics review

Skeletal and connective tissue disorders
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  1. Arthritis
    • Inflammation of joints
    • Reg, well balance diet
    • best rest, aspirin
    • normocytic anemia may present, inflammation of arthritis prevents reuse of iron
  2. Systemic Lupus Erythematosus (SLE)
    • No spec diet
    • supplement iron, folate, ca, fiber, b12
    • may show symptoms of celiac
  3. Bone disorders
    • osetoclasts reabsorb and remove bone,
    • oteoblasts reform bone
  4. Otesoporosis-loss of bone tissue
    • (1) Postmenopausal within 15-20 yrs (2) age associated
    • causes: malnutrition, lack of exercise, decline in estrogen
    • treat: HRT (hormone replacement therapy), weight bearing exercise, vit D, Ca
  5. Osteomalacia
    • Adult Rickets
    • Vit D defiency
    • give vit d and calcium
  6. Epilepsy
    • Seizures, altered consciousness
    • Anticonvulsants interfere with Ca abs
    • -take folate with drugs, vit d, ca, thiamin
    • Ketogenic diet: high fat (80-90%), low CHO
  7. Cerebral Palsy
    • brain damage, inadequate control over voluntary muscles
    • Spastic: high fluid, high fiber diet
    • non-spastic: uncontrollable wiggling causes low weight
    • high cal/hi pro/ finger foods
  8. Paralysis
    • Stroke
    • decreased ability to abs ca, loss of nitrogen

    • Spinal cord injury
    • energy needs are 10% below predicted, at least 1.5 L of fluid
    • Pressure ulcers: 30-40 cal/kg
    • 1.2-1.5 g/kg pro
    • supplement vit c, get vit a from intake
  9. Hyperkinesis
    • ADHD
    • Feingold diet: no salicylates, artificial colors or flavors (efficacy not proven)
    • sugar does not cause hyperactivity
  10. Alzheimer's Disease
    • Avoid distractions (no TV), regular consistent mealtimes, encourage self feeding, offer one course at a time
    • lower sat fats, avoid dehydration
    • may need verbal cues to chew and swallow
  11. Anemia
    Decrease in total RBC mass bc less RBC's or smaller cells with less Hg
  12. microcytic, hyopchrmoic anemia
    small, pale cells, due to iron deficiency--associated with chronic infections, renal disease
  13. macrocytic, megaloblastic anemia
    • FEW large cells, filled with Hg
    • due to deficiency of folate or B12--Schilling test for pernicious
  14. Infant allergies
    • Cow's milk protein is the single most common allergen for infants
    • introduce eggs at 24 months, nuts and fish at 36
  15. Food intolerance
    abnormal response, GI distress but NO antibody production

    *Antibodies are produce when antigen enters*
  16. Fever and Infection
    • Excessive fluid loss, IV dextrose and water
    • BMR increases 7% for each degree rise in F, normal: 98.6
  17. Burns
    • Immediate shock period-catabolism, BMR rises 50-100%
    • replace fluids and electrolytes
    • Increase cals 1.5-3 g pro
    • Vit C & zinc for wound healing
    • Water sol vits, 2x DRI
    • vit K if on antibiotics
  18. Ebb Phase
    Hypovolemia, shock, tissue hypoxia
  19. Flow Phase
    • follows fluid resuscitation and return of oxygen transport
    • flight or fight (ephinephrine, norepinephrine)
    • aldosterone
    • ADH-renal water resbs
    • hyperglycemia
    • fluid and sodium retention
    • 1.5-2 g pro
  20. Neoplastic Disease
    • causes protein-calorie malnutrition, malabsorption, fluid and elec imbalances
    • 1. add flavorings and seasoning
    • 2. meat aversions
    • 3. thrush from oral infections: avoid spicy, acidic

    *throat or neck cancer: PEG for feeding*
  21. Radiation
    • loss of taste, xerostomia (dry mouth), esophagitis
    • mucositis: avoid fresh, raw foods
  22. Chemotheraphy
    • Chemical reagents which have toxic effects
    • 1. nausea
    • 2. stomatitis: cracks in skins at mouth corners (riboflavin deficiency)
    • 2. methotrexate: anti-folate drug
  23. Marasmus
    • Protein/calorie starvation
    • severe wasting, anthropometrics, no edema
    • serum albumin normal
  24. Iatrogenic Malnutriiton
    • Protein/Calorie malnutrition
    • brought on by treatment, hospitals, medications
  25. Anorexia nervosa
    • distorted body image, preoccupation with food and weight gain
    • 1. Correct elec imbalance
    • 2. Plan meal times
    • Realistic and Flexible 
  26. Bulemia
    damage to teeth, throat, esophagus
  27. Ghrelin
    hunger stimulating hormone

    High in those with Prader Willi
  28. Dental Caries
    • bacterial enzymes ferment CHO on plaque
    • Foods that can cause: ched cheese, nuts, meat
    • Sugar alcohols DO NOT
    • do not give children toothpaste until they can spit it out (2-3 yrs) bc of fluoride

    *infants should not sleep with a bottle
  29. Stomatitis (inflammation of the mouth)
    • Associated with riboflavin def
    • avoid very hot/cold foods, spices, sour/tart
  30. Esophagitis
    • Treat by decreasing gastric acidity, reflux
    • Diet: small, low fat, bland, low fiber

    Achalasia: LES motility, causes dysphagia, start with pureed
  31. Pregnancy Induced Hypertension
    • Hypertension, edema, proteinuria, rapid weight gain after 20th week
    • do NOT sodium restrict
    • could be from poor prenatal care, poor diet
  32. Hyperemesis gravidarum
    severe pregnancy nausea, bed rest and freq cho feedings
  33. Acquired Immune Deficiency Syndrome (AIDS)
    1. diarrhea, malabsorption, nausea, vomiting, weight loss

    • 1.3 x BEE
    • if wasted 1.2-2 g pro
    • preserve lean body mass

    • Avoid Raw foods
    • HIV Pos should not breastfeed
    • Retrovir causes non-nutr macrocytic anemia
    • do not use any drugs with
  34. Pediatric HIV
    • High cal/pro with supplements for wgt gain
    • vits/mins 1-2x DRI or RDA
  35. COPD-Chronic Obstructive Pulmonary Disease
    • Persistent obstruction of pulmonary airflow
    • emphysema & chronic bronchitis
    • symptoms: weight loss, emaciation, anorexia
    • maintain stable wgt, high cal/pro
    • 1-1.5 g/kg pro 30-45% as fat
  36. ARDS: acute respiratory distress syndrome
    • Respiratory failure
    • Lungs cannot exchange gas
    • Severely underweight-goal to maintain stable weight, provide adequate but not excessive cals
    • EPA abd GLA enteral formulas
    • 1.5-2 g pro
  37. Standard Polymeric Enteral Nutrition
    • Normal GI function
    • lecithin may be added
    • 1-1.5 cals/cc
    • intact protein, and isotonic (osmolality is close to that of blood)
    • osmolite
  38. Elemental, Chemically define Enteral Nutrition
    • Used with malabsorption, comp GI funcion, 
    • Predigested protein, glucose, fat, vit/min
    • absorbed in proximal intestine, low to no residue
    • dont need panc enzymes
    • Vivonex, Peptamen
  39. Specialized Enteral Nutrition
    • Nepro-Renal
    • Pulmocare, Respalor: high fat, low cho-pulmonary
    • Hepatic Aid: liver
    • Glucerna: Diabetes
    • the more specialized the more $$$
  40. Tube Bore (opening)
    • based on viscosity of feeding
    • Large #16: blenderized whole foods
    • Small #8: ready prepared formulas
  41. Enteral Methods
    • Bolus: for those with functional stomach
    • Continuous drip: steady rate over 16-24 hours. For those who have compromised GI funcion
    • Cyclic feeding: continuous drip at a increased rate throughout the night, for elderly or under-nourished.
    • Intermittent drip: Pump or gravity-more mobile
    • Nasduodenal or nasojejunal: if unable to tolerate gastric feedings
    • Traspyloric: used in comatose pts

  42. Water with tube feeds
    • 1 cc/ calorie
    • 1 cal/cc formulas are 80-86% water; 1.5 cal/cc are 76-78% water..
    • throw out open containers after 24 hrs
  43. Peripheral parenteral nutrition
    • small surface veins--short term/no effect on nutritional status
    • -post surgery when TF will start 5-7 days
    • IV dextrose: 3.4 cals/g
    • mL*%*3.4=calories
    • 3-15% protein
    • IVFE: 10%=1.1 cal; 20%=2.0 cals
  44. Parenteral Nutrition
    • infusion of hypertonic solutoin to central venous catheter
    • last option when pt cannot eat
    • Use for NC 1.4 (altered GI) and CC 2.1 (impaired nutrient utilization)
    • Concern: bacteria translocation; GALT (gut associated lymphoid tissue) is compromised--immune system is compromised
  45. Protein Solution in PN
    • Ratio for anabolism is 1 g nitrogen: 150 cals
    • 1-1.5 g/kg/day
    • cystalline AA: 3-15%
    • %=number of g of pro in 100mL of solution

    example: a 3% solution has 3 g of AA's in 100ml
  46. Energy in a PN solution
    • 35-50 cals/kg; up to 70% dextrose
    • a 10% solution provides 100mg CHO/Liter
    • to avoid overfeeding and hyperglycemia, start at <20-25 cals/kg
    • max rate of dextrose should not exceed 4 to 5 mg/kg/minute to prevent hyperglycemia
  47. Fat for a PN Solution
    • Needed to prevent EFAD
    • give 500 cc of 10% fat emulsion 1-2x/week
    • symptoms of EFAD are petechiae (red spots)
  48. TNA
    • Total Nutrient Admiztures
    • 3 in one: dextrose, AA's and lipids
  49. Transition feeding from PN 
    • Introduce a min amount of FULL-STRENGTH enteral feeding at a low rate (30-40) to get GI tolerance
    • decrease PN as you increase enteral rate by 25-30 every 8-24 hours
    • when pt can tolerate 75% of needs, d/c the PN
  50. Re-feeding Syndrome
    • aggressive adimin of nutrition to malnourished
    • starved cells take up nutrients, pot and phos shift to intracellular compartments
    • results in hypokalemia, hypophosphatemia, hypomagnesemia

    overfeeding PN and dextrose >5 mg/kg/min may lead to hyperglycemia
  51. CAM (Complimentary and alternative medicine)
    • mind-body meds
    • acupuncture, oriental meds
    • lifestyle, herbs, chiropractic
    • bioelectric magnetics